Hello Rheumatology Fans,
In this article, we are going to explore the 24-hour pattern of symptoms seen in Systemic Inflammatory Pathologies.
In the realm of rheumatology and physiotherapy, understanding the nuances of inflammatory patterns is crucial. This helps us differentiate various pathologies i.e. musculoskeletal or injurious compared to systemic inflammatory. Take the case of back pain, there can be all manner of causative factors and we need to whittle them down somehow.
The Morning
The break of dawn brings with it a unique set of challenges for individuals grappling with inflammatory conditions. Morning stiffness is familiar to many but protracted joint or spinal stiffness that lasts 60 minutes plus, sometimes not remitting through the entire day is more unusual but is extremely common in those with a systemic inflammatory condition.
Pain and stiffness are usually at their worst during the first few hours of the morning easing as the day progresses. This relates to a combination of factors, the bodies circadian rhythm and inflammatory activity as well as having spent 6-10 hours in a relatively static position in bed.
Midday
As the day progresses, so does the ebb and flow of inflammatory activity. During this period it is required to strike a balance between activity and rest. Many people with inflammatory pathology respond well to activity but can overdo it as well. Associated symptoms such as fatigue can often be worsened with higher levels of activity.
There is the importance of pacing and tailoring physical activity to align with the individual’s requirements. Some tasks have to be done, especially occupational ones, and having enough reserves to complete recreational activities is vital. It can take some trial and error to strike this balance.
The Evening
As the sun begins its descent, so does the intensity of inflammation within the body. The evening is a time when many individuals experience a subtle easing of symptoms, this can be useful to get tasks or exercise programs done.
As we will explore in sleep disturbance however, we also need to consider winding down before attempting to sleep. Flying around at 200 miles per hour right up until trying to close eyes is oftentimes unhelpful. As much as I dislike the phrase “sleep hygiene” having a bedtime routine is important.
Sleep (Disturbance)
Unfortunately, there is little if any respite in the night from symptoms for people with systemic inflammatory disorders. Commonly going to sleep is not too much of an issue but they are often woken in the second half of the night by a return or increase in intensity of their symptoms. This is particularly highlighted in inflammatory back pain.
Night symptoms are vital clues in many disorders including sinister or emergency pathology and so qualifying the presence of these is paramount. Is the person waking at a similar time, is it every night, what do they do when they wake to get back to sleep are important qualifiers.
The further impact on the person comes with the fatigue, this can be caused directly by the inflammatory pathology or the lack of sleep from waking repeatedly. I find a useful line of questioning to be about the fatigue levels when they have had a good night sleep (if they have!). You might see this written or explained as “waking unrefreshed”.
Practical Takeaways
Embrace the rhythm: Embracing the natural ebb and flow can guide decisions about when to engage in physical activity, when to rest, and when to optimise therapeutic interventions.
Tailor The Day: Personalise daily routines to accommodate unique inflammatory patterns. Understanding when peak symptoms are experienced allows planing of activities and rest periods effectively.
Ask The Right Questions: When considering inflammatory pathology as a differential diagnosis ensure you have a good handle on the 24 hour pattern of symptoms paying attention to the morning and night time. Look for the clues of joint or spinal stiffness and their duration.
Closing
The 24 hour of pattern of symptoms in inflammatory pathology is a small part of a large and complex picture. It is one part that significantly affects a persons function. Just imagine waking at 2am every morning with joint pains and then when you try and get ready for the day, your hands or spine barely move for the first 2 hours…
Audio and Video Versions
Keep reading with a 7-day free trial
Subscribe to The Rheumatology Physio to keep reading this post and get 7 days of free access to the full post archives.